on February 13, 2003
Stroke. 2003
Published online before print February 13, 2003, doi: 10.1161/01.STR.0000056944.42686.1E
Published online before print February 13, 2003, doi: 10.1161/01.STR.0000056944.42686.1E
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Submitted on September 16, 2002
From the Department of Neurology, Cleveland Clinic Foundation (I.L.K., M.D.H., A.J.F.); Quality Institute, Cleveland Clinic Health System (E.D.H., D.M.N.); and Center for Health Care Research and Policy, MetroHealth Medical Center (I.L.K.), Cleveland, Ohio. * To whom correspondence should be addressed. E-mail: katzani{at}ccf.org.
Background and Purpose--A systematic audit of intravenous tissue-type plasminogen activator (tPA) use and stroke outcomes in Cleveland, Ohio, during 1997-1998 demonstrated higher rates of symptomatic intracranial hemorrhage (ICH) than reported in the National Institute of Neurological Disorders and Stroke (NINDS) trial. We now report updated results of intravenous tPA use in the Cleveland Clinic Health System (CCHS). Methods--A stroke quality improvement program was initiated in the 9-hospital CCHS in 1999. A retrospective chart review for all stroke patients with primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 434 and 436 admitted to the 9 hospitals from June 1999 to June 2000 was used to determine outcomes of patients treated with intravenous tPA. Results--Intravenous tPA was given to 18.8% of patients arriving within 3 hours of symptom onset. Protocol deviations occurred in 19.1% of patients given intravenous tPA. The symptomatic ICH rate was 6.4%. Conclusions--Since 1997, intravenous tPA use has increased, while the rates of symptomatic ICH and protocol deviations have decreased in the CCHS. The CCHS symptomatic ICH rate is now similar to that reported in the NINDS trial. These improvements occurred after initiation of a stroke quality improvement program.
Accepted on September 19, 2002
Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke. A Cleveland Update
Irene L. Katzan MD, MS*;
Key words: cerebral infarction • quality of health care • thrombolytic therapy
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